| NPI | 1639738958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: WI 81281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151014014) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-12-20 |